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GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received__ .,/Oy'~ ~-'Al~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FaR
e
4
TyDe of F~cility to be Inspected:
Number of Bedrooms:
~ ~ ...... ~ ~/ B. Depth
A. TvDe v~-~ ~-
C. Construction D, Bacterial Analysis
D. Seepage Pit: 1. Size 2. Material
H. Disposal Fie~d: Total Length of Lines /~
Distances:
A. Well To:
B.
C.
Septic Tank ~00 ~.~r ,
o'
, Nearest Lot [,ine~ , Other Contamination
Foundation to Septic T~nk (~ ",, Absorption Area ~0 ¢
Absorption Area to Nearest Lot Line ( 0 /
Absorption Area /70 ( , Sewer Lines
Req,Je~t for Approval of Inoividual Sewer & Water Facilities
Paqe Two
Comments:
Annrove roved Date
Approval /alid for One Year From Date Signed
Greater Anchorage Area Borough, DeF~rtment of ~nvironmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located at:
Signed Date
~HA Form 2573
Rev. JuDy 1958 FEDERAL HOUSING ADMINISTRATION Form Approved
Budget Bureau No. 63-R296.8
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERIAL NO.
And:hob-ag% ~la~ First National Bank of Anchorage 60-0074~O
MORTGAGOR OR SPONSOR PROPERTY ADDRESS
Alla~ ~, ~r~is A~chorage, Alaska
SUBDIVISION NAME --
TOTAL NUMBER:
LIVING UNITS BEDROOMS BATHS BASEMENT ~1 New installation Can attic or other area be made into
____ additional bedrooms?
(If Yes, how many~)
1 ~, ]. r-1 Yes [~]No r-1 Yes ~-~No
WATER SUPPLY BY:
[] ~ SYSTEM DESIGHED FOR
L_J Public system Community system Individual NO. OF BDRMS. GARBAGE DISPOSAL
SEWAGE DISPOSAL BY:
kJ Public system [~J Community system ~ Individual 2 [~] Yes [~ No
PART II.--lO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
_ ~_. ~ --~/~/~_._._.~__,
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It is the opinion of the [--} State ['--] .County r-] Local Department of Health that this individual Water-supply system
[--] is ~] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the ~] State ['[ County k.[ Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
[~l Can be expected to function satisfactorily, and ~] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
-,~ - Ig-lo' . ~5,,o;,o z~'~,~,'~,,.
NOTE, The health authority should complete tho/appro ri r~late opinion statement above and affix dote, signature an/d title in
spaces provided.
Use of the above grid for Health Department Inspector's sketch as well as use of the back of this form is at the option of the
health authority.
PART Ill.--FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that 'the
Individual water-supply system be considered [-~ Acceptable [] Not Acceptable
Sewage disposal be considered [-'] Acceptable F"] N~t Acceptable.
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
FHA Form 257:
Rev. July 1958
¸61
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